Mental health in the U.S. requires structural change, not individual action. (CW: mention of suicide)

In the wake of last week’s news of the deaths of Kate Spade and Anthony Bourdain — who died, back-to-back, by suicide — we are left to grapple yet again with mental health in America and what it means about all of us when even seemingly hyper-successful people struggle to stay afloat and stay alive.

It’s proof of how far the capitalist mentality has seeped into the American consciousness that the immediate reaction to any death by suicide is to agitate for increased individual responsibility — “reach out to your friends, check in!” becomes the national cry, as well as consistent invocation of the suicide hotline. The onus remains squarely on the individual — for the mentally ill person or the person who has died, the implicit accusation is that health and recovery would come if only they could do more work to reach out and get help. And, despite what the more able and compassionate among us might say (or tweet) about being available to support their suffering friends, in reality, most of the time most people are too bogged down in the day to day emotional strife of living in America to be able to extend their emotional resources to a friend so seriously ill as to consider suicide. People have limited emotional capacity, and that’s okay — the trap we’ve fallen into is thinking that the primary responsibility of healing mental illness in this country is on individuals.

In actuality, all of us are struggling constantly to stay afloat — some have the resources to do so more easily or successfully. Individual resources are finite, community resources may stretch further, but truly the state has the greatest capacity to effect change for the most people. Universalized access to additional supports such as therapy and medication, access to jobs that pay enough for folks to eat and live well, access to free time and nature, safe housing, and so on, would immensely improve mental health in America.

We can’t ignore the fact that there are many overlapping structures that disallow mental well-being — reasons that folks who are already prone to mental illnesses will experience them more severely, and reasons that situational mental illnesses abound as well.

Marginalized groups experience discrimination and micro- and macro-violences that degrade their mental well-being — this includes racism, ableism, and homo/transphobia, among others. Poverty is a big contributor to mental illness, and includes not only the fact of being poor, but also the things that prevent people from gaining wealth or financial stability. Access to jobs is connected to houselessness, which is connected, for example, to addiction, to homophobia and transphobia in the home that force queer youth into the streets, and also to racial, homo/transphobic, and classist discrimination in the workplace. Also connected to joblessness is lack of access to higher education due to the exorbitant and ever-rising costs of college, and lack of access to even primary education in areas with high high school dropout rates. And all of these individual factors contribute to mental health problems too. Social support that would allow folks access to education, job training, mental health services, medical care, and so on, do not exist or do not function in a way that meets a massive need for them.

When people are in a place to reach out and ask for mental health supports, they often face continued discrimination in trying to seek therapy —people of color are selected against by therapists in America, who as a group are largely white and tend to select white and female clients. Queer and trans people face a dearth of therapists who are affirming of their sexualities and genders, and may end up avoiding therapy to avoid the invalidation and emotional violence they might suffer. Mental health medication is prescribed by psychiatrists who, if you have health insurance to begin with, are frequently out-of-network, making their hundreds-of-dollars-an-hour costs a huge barrier to those who need medications to manage their mental illnesses. There is very little state support or subsidies for mental health medication.

Structural change is necessary if we truly want to improve mental health in the U.S. This is not an all-inclusive article — mental health is complex and layered, and there is no simple “fix.” But there are factors we can begin to address with policy and programs that would up the baseline for mental health in the U.S. Focusing the conversation on individual actions to prevent suicide obscures a greater need for conversations about what will truly help mental illness on a national scale — structural change and social supports.

Consider, too, whose deaths we see and whose deaths we do not see, and remember that American society has been intentionally constructed so that this is the case — we don’t see the homeless, we don’t see the mentally ill, we don’t see queer people, we don’t see people of color, we don’t see the poor — so when people who are high in the public eye die by suicide and open up this important conversation, remember whose voices are left out and bring them to the table.